Angústia de morte sentida pelos profissionais de saúde, face aos doentes em fase terminal

O presente trabalho aborda as dificuldades sentidas pelos profissionais de saúde perante os doentes em fase terminal. É importante percebermos como é que os profissionais de saúde se preparam psicologicamente para tratar dos pacientes com o profissionalismo que lhes é pedido. O trabalho recai, na tentativa de verificar, a forma como conseguem “escapar” a esta ligação directa com a morte. Participaram neste estudo do tipo exploratório, 4 enfermeiras e 1 médica da Unidade da Dor do Hospital Garcia de Orta, que através de entrevistas semi-directivas, descreviam as suas experiências. Abordámos o percurso profissional, as dificuldades no dia-a-dia, as situações mais gratificantes, a função da equipa e o processo de luto. Nos resultados obtidos, utilizámos como método a análise de conteúdo. Os resultados destacaram a identificação, como a maior dificuldade, lembrando desta forma que os profissionais de saúde, também sofrem com a perda dos doentes, como se de alguém próximo se tratasse, complicando a relação profissional e levando a que normalmente se usem mecanismos do evitamento. Concluímos que é indispensável o apoio da equipa multidisciplinar, de forma a acolher todos os acontecimentos que provocam desconforto e angústia em relação à morte, por mais mecanismos utilizados é impossível dissociar a relação profissional da pessoal.

Responsabilidad civil de la persona mayor incapaz y de sus guardadores por los daños causados a terceros: especial referencia a la responsabilidad del incapaz en el sistema del Common Law

Un número considerable de personas mayores padece alguna enfermedad neurodegenerativa que limita sus facultades intelectivas y volitivas, lo que en la práctica suele traducirse en alteraciones de la personalidad con conservación de consciencia, pérdidas de memoria, desorientación, inquietud, confusión o agresividad. Este deterioro progresivo de capacidad que puede afectar a nuestros mayores no sólo los convierte en fácil objetivo de agresiones sino también en potenciales creadores de riesgos y daños a terceros. Es precisamente la responsabilidad que puede derivarse de tales daños la que será analizada en primer lugar en esta sede, exponiendo el estado de la cuestión tanto en el civil como en el common law. Por otro lado, cuando una persona que tiene sus funciones cognitivas mermadas causa un daño a otro, no sólo se debe analizar la responsabilidad civil del propio agente del daño frente al perjudicado, sino también aquélla en que podría incurrir la persona encargada de su cuidado en caso de haberla. Dicha cuestión ocupará la segunda parte del presente trabajo.

Le sommeil comme marqueur du déclin cognitif dans la maladie de Parkinson

La maladie de Parkinson (MP) est une maladie neurodégénérative qui se caractérise principalement par la présence de symptômes moteurs. Cependant, d’autres symptômes, dits non moteurs, sont fréquents dans la MP et assombrissent le pronostic; ceux ci incluent notamment les désordres du sommeil et les troubles cognitifs. De fait, sur une période de plus de 10 ans, jusqu’à 90 % des patients avec la MP développeraient une démence. L’identification de marqueurs de la démence dans la MP est donc primordiale pour permettre le diagnostic précoce et favoriser le développement d’approches thérapeutiques préventives. Plusieurs études ont mis en évidence la contribution du sommeil dans les processus de plasticité cérébrale, d’apprentissage et de consolidation mnésique, notamment l’importance des ondes lentes (OL) et des fuseaux de sommeil (FS). Très peu de travaux se sont intéressés aux liens entre les modifications de la microarchitecture du sommeil et le déclin cognitif dans la MP. L’objectif de cette thèse est de déterminer, sur le plan longitudinal, si certains marqueurs électroencéphalographiques (EEG) en sommeil peuvent prédire la progression vers la démence chez des patients atteints de la MP. La première étude a évalué les caractéristiques des OL et des FS durant le sommeil lent chez les patients avec la MP selon qu’ils ont développé ou non une démence (MP démence vs MP sans démence) lors du suivi longitudinal, ainsi que chez des sujets contrôles en santé. Comparativement aux patients MP sans démence et aux sujets contrôles, les patients MP démence présentaient au temps de base une diminution de la densité, de l’amplitude et de la fréquence des FS. La diminution de l’amplitude des FS dans les régions postérieures était associée à de moins bonnes performances aux tâches visuospatiales chez les patients MP démence. Bien que l’amplitude des OL soit diminuée chez les deux groupes de patients avec la MP, celle ci n’était pas associée au statut cognitif lors du suivi. La deuxième étude a évalué les marqueurs spectraux du développement de la démence dans la MP à l’aide de l’analyse quantifiée de l’EEG en sommeil lent, en sommeil paradoxal et à l’éveil. Les patients MP démence présentaient une diminution de la puissance spectrale sigma durant le sommeil lent dans les régions pariétales comparativement aux patients MP sans démence et aux contrôles. Durant le sommeil paradoxal, l’augmentation de la puissance spectrale en delta et en thêta, de même qu’un plus grand ratio de ralentissement de l’EEG, caractérisé par un rapport plus élevé des basses fréquences sur les hautes fréquences, était associée au développement de la démence chez les patients avec la MP. D’ailleurs, dans la cohorte de patients, un plus grand ralentissement de l’EEG en sommeil paradoxal dans les régions temporo occipitales était associé à des performances cognitives moindres aux épreuves visuospatiales. Enfin, durant l’éveil, les patients MP démence présentaient au temps de base une augmentation de la puissance spectrale delta, un plus grand ratio de ralentissement de l’EEG ainsi qu’une diminution de la fréquence dominante occipitale alpha comparativement aux patients MP sans démence et aux contrôles. Cette thèse suggère que des anomalies EEG spécifiques durant le sommeil et l’éveil peuvent identifier les patients avec la MP qui vont développer une démence quelques années plus tard. L’activité des FS, ainsi que le ralentissement de l’EEG en sommeil paradoxal et à l’éveil, pourraient donc servir de marqueurs potentiels du développement de la démence dans la MP.

A arquitectura do mosteiro cartusiano de Santa Maria Scala Coeli: do processo de entrada

A importância da encenação de uma transição entre o mundo secular e a vida em clausura, no contexto da arquitectura cartusiana, é amplamente demonstrada através dos percursos de entrada dos conjuntos mais relevantes, bem como em muitos daqueles representados nas gravuras presentes no livro Maisons de l’Ordre des Chartreux – Vues et Notices, uma obra do início do século XX que inclui gravuras da quase totalidade dos 282 mosteiros cartusianos distribuídos por quase toda a Europa. Na maioria das cartuxas podem observarse transições indirectas e prolongadas, capazes de tardar o passo e dar significado à passagem para a clausura – características espaciais que São Bruno, fundador da casa cartusiana, considerava primordiais para a implantação do seu eremitério. A partir de uma cuidada análise dessa transição, nas cartuxas em geral, e da sua evolução morfológica, na cartuxa de Évora em particular – estimulada pela descoberta de dados aqui analisados e interpretados pela primeira vez – apresenta-se, em continuidade com a sua história e tendo como premissa a consolidação do processo de entrada, uma proposta de redefinição da estrutura monacal de Santa Maria Scala Coeli. Esta estrutura originária do século XVI encontra-se incompleta e degradada, em particular na ala sul onde se encontra o seu principal acesso, sendo fundamental o completamento desta área para o cabal reconhecimento da unidade do conjunto e da intenção na qual se traduz a sua génese. De resto, a estratégia de investigação e de projecto descrita nesta dissertação pode ser encarada como um processo plausível de ser utilizado no caso de futuras intervenções noutras estruturas cartusianas, contribuindo assim para a recuperação e preservação do conceito fundador da identidade da arquitectura cartusiana que, no decorrer da expansão da ordem, se foi perdendo; The Architecture of the Carthusian Monastery of Santa Maria Scala Coeli: About the process of entrance. ABSTRACT: The importance of staging a transition between the secular world and life cloistered in the context of Carthusian architecture is amply demonstrated through the input paths of the most important collections, as well as many of those represented in the pictures in the book Maisons de l’Ordre des Chartreux – Vues et Notices, one of the early twentieth century work that includes prints of almost all of the 282 Carthusians monasteries spread across almost all of Europe. In most of Carthusian the transitions that can be observed are indirect and long, able to delay the step and give meaning to the passage to the life cloistered - spatial characteristics that St. Bruno, founder of the Carthusian Order, considered essential for the implementation of his hermitage. From a careful analysis of this transition, looking through the Carthusian in general, and its morphological evolution, in the Charterhouse of Évora in particular, encouraged by the data discovery here analyzed and interpreted for the first time - it is presented in continuity with its history and having premised on the consolidation of the entry process, a proposal for a redefinition of the monastic structure of Santa Maria Scala Coeli. This original structure of the sixteenth century is incomplete and degraded, particularly in the south wing where it is the main access, and where is fundamental the completion of this area to the full recognition of the unity of the whole and to understand the intent in which translates its genesis. Moreover, the research strategy and project described in this paper can be seen as a plausible case to be used in case of future interventions in other cartusianas structures, thus contributing to the recovery and preservation of the founder of the identity concept of the Carthusian architecture that, during the expansion of the order, was missing.

La Teoría General del Derecho como asignatura necesaria en el plan de estudios de la carrera de abogacía

Las ramas jurídicas son estudiadas por el estudiante de Abogacía en asignaturas separadas a lo largo de la carrera. Ahora bien, es necesaria una asignatura al final de la misma que reúna a todas las ramas del Derecho estudiadas separadamente. Es decir, una visión de síntesis de todas las ramas del mundo jurídico. Esa asignatura necesaria es la Teoría General del Derecho. La misma aporta la noción de “unidad” del fenómeno jurídico, es decir, la comprensión del Derecho como “sistema jurídico”. Permite al estudiante avanzado la reflexión superadora de las particularidades de cada rama del Derecho y el enfoque de lo “común” y lo “abarcativo” de todo el fenómeno jurídico. La asignatura debe constituirse en el camino para que el alumno avanzado de Derecho logre autónomamente la comprensión y reflexión de: la noción de unidad del Derecho, la finalidad del Derecho, la idea de cambio en el Derecho, la noción de complejidad pura del Derecho, la noción de rama jurídica, la noción de autonomía de las ramas, la crisis de las respuestas que brindan las ramas jurídicas tradicionales, y el replanteo sobre la necesidad de surgimiento de nuevas ramas jurídicas.

La imagen en el discurso multimodal cortazariano, una poética en movimiento

The selection and proposed cortazarian image in multimodal speech, a poetic moving as a doctoral thesis title, is the result of a process that forms several progressive stages. more than satisfy our curiosity and literary artistic concerns, the questions multiply increases our desire to bring more creative Cortazarian the colossus, that not only ruins a way of making literature , but in its revolutionary labyrinth gives a turn of the screw to the already tangled world of artistic writing , breaking in 1967 with the first of four hybrids books, La vuelta al día en ochenta mundos through which converts the traditional plastic unitextual and unimodal space in a palempsesto inexhaustible generator senses and meanings. Far from appeasing the wrath of conservative critics, caused by his narrative masterpiece, Hopscotch (1963), sparked the debate to denounce the regression of the classic molds of writing, proposing the imagination as the setting for creative freedom, it is not as arbitrary and nonsense, but as a process of higher state of consciousness in which it operates an underlying logic. Hence, our objective is to crawl into the underworld and plastics other multisígnicas border spaces, fleeting and ephemeral alliances that relate not just as complementary and similar texts which may be the same speech and can transmit the same, but quite the contrary, the oft-repeated notion of analogy is the first victim, fortunately, this kind of creative-artistic operations that raise the creative act to a sublime state capable of converting the inexhaustible multitextuales constellations in different ways: opposition, confrontation, invasion, dialogue, shadow, duplication, theft, etc. However this multiple transgression pushed to the limit by Julio Cortazar and his friend Julio Silva through four books proposed for analysis often does not translate into jobs and research in literature departments of the universities of the world, nor the critics are echoes the striking abundance and clarity of expression multimodal phenomenon as is the case with other works of Cortazar unimodal type, which makes it impassable fences mysterious worlds...

New worlds and new churches: The Orthodox Church(es) and the European Union

The Orthodox church(es) share a common commitment to the unity of dogma and spirituality. There is, however, no doctrinal formulation that comes close to a form of political theology at a pan-Orthodox level. This means that the Orthodox churches’ attitude towards the European Union (EU) is driven by their ecclesial diversity and by complex inter-ecclesial relations. More fundamentally they share a fragmented and plural, theological objection to the very ideas of Europe and the West. This has been further complicated by the emergence of a substantial Orthodox diaspora from Eastern Europe, Russia, and the Middle East living across the breadth of the European continent. Consequently the ecclesial identity and self-perception of the autocephalous Orthodox churches is changing. These churches are becoming increasingly transnational and extra-territorial. With this, their perception of Europe and the West, as seen through the eyes of their diaspora communities, is altering from “threat” to “home” (Makrides and Uffelmann, 2003). The growing diaspora will not only impact the Christian demographics of Europe but will also transform the Eastern Churches’ view of Europe and the EU (Leustean, 2009; 2011; 2013; 2014a; 2014b).

Unidade na diversidade? A resposta da União Europeia à Rússia durante a crise ucraniana

Mestrado em Economia Internacional e Estudos Europeus

Igual consideração e respeito, independência ética e liberdade de expressão em Dworkin : uma reconciliação entre igualdade e liberdade e a possibilidade do discurso do ódio em um ordenamento coerente de princípios

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Direito, Pós-Graduação Stricto Sensu em Direito, 2016.

Re-conceptualiser notre expérience de l’environnement audio-visuel qui nous entoure : l’individuation, entre attention et mémoire

Notre mémoire prend en charge de re-conceptualiser notre nouvel environnement audio-visuel et l’expérience que nous en faisons. À l’ère du numérique et de la dissémination généralisée des images animées, nous circonscrivons une catégorie d’images que nous concevons comme la plus à même d’avoir un impact sur le développement humain. Nous les appelons des images-sons synchrono-photo-temporalisées. Plus spécifiquement, nous cherchons à mettre en lumière leur puissance d’affection et de contrôle en démontrant qu’elles ont une influence certaine sur le processus d’individuation, influence qui est grandement facilitée par l’isotopie structurelle qui existe entre le flux de conscience et leur flux d’écoulement. Par le biais des recherches de Bernard Stiegler, nous remarquons également l’important rôle que jouent l’attention et la mémoire dans le processus d’individuation. L’ensemble de notre réflexion nous fait réaliser à quel point le système d’éducation actuel québécois manque à sa tâche de formation citoyenne en ne dispensant pas un enseignement adéquat des images animées.

A graduate piano recital : an analytical study

The purpose of this thesis is to provide a historical and musical analysis that illustrates characteristic features of musical compositions from the Baroque, Classical, Romantic, and Twentieth century styles. The structural analysis of the pieces reveal the evolution in the musical expression regarding line, texture, form, and the technical skills employed by the composers through polyphonic, homophonic, and twelve-tone procedures. The works of this recital represent four different styles: The prelude and fugue among the important forms of the Baroque style; the sonata embodying the principles of balance and unity of the Classical style; the etude and waltz as representative of the Romantic style; and the nocturne as an illustration of the transformation of the melody, harmony, and rhythm in the music of the 20thcentury.

Re-conceptualiser notre expérience de l’environnement audio-visuel qui nous entoure : l’individuation, entre attention et mémoire

Notre mémoire prend en charge de re-conceptualiser notre nouvel environnement audio-visuel et l’expérience que nous en faisons. À l’ère du numérique et de la dissémination généralisée des images animées, nous circonscrivons une catégorie d’images que nous concevons comme la plus à même d’avoir un impact sur le développement humain. Nous les appelons des images-sons synchrono-photo-temporalisées. Plus spécifiquement, nous cherchons à mettre en lumière leur puissance d’affection et de contrôle en démontrant qu’elles ont une influence certaine sur le processus d’individuation, influence qui est grandement facilitée par l’isotopie structurelle qui existe entre le flux de conscience et leur flux d’écoulement. Par le biais des recherches de Bernard Stiegler, nous remarquons également l’important rôle que jouent l’attention et la mémoire dans le processus d’individuation. L’ensemble de notre réflexion nous fait réaliser à quel point le système d’éducation actuel québécois manque à sa tâche de formation citoyenne en ne dispensant pas un enseignement adéquat des images animées.

Kutù’và yu tu’ún va’á. Estoy aprendiendo la palabra de bienestar. Iniciación etnodramática

Is it possible from some one out side of Ñuu Saví (Mixtec) culture to learn how to do an ethnodrama? A healer and rain maker from Mixteca land is teaching me how to ask for rain and cure diseases. “Kutù’và yu Tu’ún Va’á”, is the name of my thesis and means “I am learning the wellness word”. This work is an “ethnodramatic initiation” to their sacred language. I don’t attempt to read Don Marcelino’s mind but to create a mental scenario that would help us to contemplate the internal spectacle he and his community watch during the ethnodrama of rain and healing. Finally I will represent my learning process during my initiation to body-mental technics. The subject of the thesis travels around several concepts interrelated: feast, ritual, celebration, healing, rain, knowledge, magical thinking, learning, performance… It’s related to an analogic language, oral culture, holistic perception and ethnodramaturgy. I will apply some of the concepts of Weisz’s ethnodramatic performance theory to a place located in Mexico, state of Oaxaca, Juxtlahuaca district, belonging to the municipality of Coicoyán de las Flores, El Jicaral. A wiseman from Nuun Tiaxin, Ñuu Saví, is teaching me how to speak with Rain and Sicknesses. Ethnodrama is a word used by Weisz to make the difference between theatre, and an ethnic paratheatrical performance. The ethnic drama is a mythological text, that it is seen inside the mind of the community members. Weisz conceives the concept as part of a greater project called, Anthropology of Knowledge, that studies the imaginary solutions to explain the formation of the world, the universe and the inscribed rituals in all great antique cultures Weisz [1994b:29]. Curanderismo, quackery, belongs to a illegitimate literature, it is something no serious. An art that goes beyond the canons of a written text and does not match with the categories of our cultures. It threatens the monolithic solidity of our academic reality and then it’s excluded. Weisz proposes to study shamanic text from a marginal position in front of a central culture that only recognizes as valid certain texts. The ethnotexto is uncomfortable, it intimidates the unity of the group of the dominant culture. Curanderismo places itself then in a position that questions a conceptual colonization, that “behavior and ideology that nourish themselves from a totalizing strategy”. A colonization that transcends Europe, related to power and to the dominant position. This is how Literature field is created Weisz [2005: 102-103]...

Sintaxis del discurso en Dt 4, 1-40

Dt 4, 1-40 it a Biblical text particularly relevant, both for its location and sense within the Deuteronomy book, as well as for its relation with the overall Deuteronomist literature. However, we do not handle in-depth and extensive studies of this text, with exception of the works published by G. Braulik516, D. Knapp517 and K. Holter518, and other exploratory studies much thoroughly investigated, as well as small monographic ones specified in a particular matter. On the other hand, the investigation of the text has been focused mainly around the historical and theological analysis of it, with the purpose to determine the time in which the text was introduced in the total of the book, as well as to weight the significance of the different stratum of the text, its sources... For this reason, other medium of approach to the text has been left aside, or had been used only as instruments to be served to the main purpose of this study. This has been for instance the study of the literary analysis. Nevertheless, during these last years, the literary investigation of the biblical texts (linguistics, narrative, rhetoric, comparative literature...) has gained boom, and had allowed a great appreciation of these texts, overall its historical or theological relevance. Dt 4, 1-40 has been benefit from all of it. The studies dedicated to the literary analysis of Dt 4, 1-40 show considerable patterns on the ways they had been carried. We have analysed them from the syntax and narrative points of view, fields very little investigated up to now. We believe it is necessary to study the text from these two perspectives to appreciate the wealth of this literary composition beyond the topics covered on it, and to contribute this way to a deep investigation of such a significant text in shape and content for the present Biblical Philology. The final objective of our study it is to arrive to a full comprehension of the thematic and literary unity of the text through its syntactic and narrative analysis, and, at the same time, to determine the mutual and necessary relationship that exist between one to another in this line of investigation...

Valoración del dolor en el paciente con trauma grave y ventilación mecánica no comunicativo

Pain is defined since 1979 by the International Association for the Study of Pain (IASP) as "unpleasant subjective, sensory and emotional experience associated with actual or potential damage of tissue", with the concept more acceptable in our days. The Intensive Care Unit (ICU) is a complex environment to assess pain, where the difficulty in communication with the patient is the biggest barrier to getting your "selfreport", which is considered the gold standard in pain assessment. Many factors alter communication with critically ill patients, as the low level of consciousness, mechanical ventilation, sedation, and the patient's own pathology, besides, there are other limitations such as excessive technology or devices that can divert professional attention to the patient's pain behavior, and lack of training and guidance for management. The multicenter study SUPPORT, it showed that 50-65% of critical patients included suffered pain, and 15% of them reported moderate to severe intensity for more than half the period of hospitalization. Critically ill patients experience pain due to high volume of potentially painful techniques applied to them during their ICU admission, emphasizing nursing care and tracheal suctioning, mobilization, wound healing and channeling of catheters and others. The underestimation of pain involves physiological and hemodynamic effects such as increased blood pressure and/or heart rate, altered breathing pattern, and psychological and anxiety. Also an increase of sedation and mechanical ventilation time and ICU stay of increasing the morbidity and mortality of critically ill patients...